Experience of a Mother‑Newborn Care Unit (MNCU) in India – A successful example of Zero Separation

Mother-Newborn Care Unit / Fig. 1 from the Chellani et al. (2022) article

In the iKMC study, the effect of immediate kangaroo mother care (KMC) was investigated. Researchers implemented new facilities where sick and small newborns resided with their mothers 24/7 and were encouraged to practice immediate KMC. This new concept showed better health outcomes for the mother and the baby, including a 25% lower death rate during the first 28 days of life. Zero separation between mothers and babies should be encouraged globally.

The practice of kangaroo mother care (KMC) after birth is not very widespread worldwide. Small and sick newborns are typically separated from their mothers and taken to the neonatal intensive care unit (NICU). Studies show that the involvement of parents in the care of their babies in NICUs leads to better health outcomes for mother and child and reduces the stress for the family. In cases where KMC is usually initiated, neonatal healthcare professionals wait for the baby to be stable, a practice that already reduces babies’ death rate by 40%.

However, knowledge of the effect of initiating KMC immediately after birth without waiting for babies to be stable was not available until recently. In cooperation with the World Health Organisation, a research group addressed this topic in the iKMC study. It was conducted in five hospitals in Ghana, India, Malawi, Nigeria, and Tanzania. Babies with a birth weight below 1799g were put in two groups: one where they receive immediate KMC (intervention group), and one where they receive conventional care in an incubator until they are stable and KMC after that (control group).

The iKMC study led to the development of the concept of the “Mother-Newborn Care Unit” (MNCU). The MNCU is a facility where sick and small newborns are cared for with their mothers being there 24/7. The rooms are equipped with all provisions for postnatal care for babies and mothers. Importantly, the mother is not considered a visitor but a resident of the MNCU and an active caregiver. Additionally, nurses are trained to provide essential postnatal care to mothers and babies.

Results from the study show that the average time allocated to skin-to-skin contact was 16.9h in the MNCU and 1,6h in the conventional NICU. Most importantly, the benefits of this prolonged and continuous KMC within the MNCU were higher breastfeeding rates, more contribution of mothers in daily care activities, better learning opportunities and lower stress levels for family members. Lastly, the study showed that babies in the MNCU had a 25% lower death rate, 35% less incidence of hypothermia, and 18% less suspected sepsis.

Challenges in the MNCU included providing respiratory support in the KMC position and practising continuous KMC while the mother was absent for medical reasons or when the baby was receiving medical treatment. These were solved with the help of relatives and with the creativity of healthcare professionals. A big challenge arrived in March 2020, when COVID-19 cases started increasing, together with concerns among healthcare professionals and patients regarding the spread of infection in the MNCU, but preventive measures like good hygiene helped to minimise infection rates.

In order to improve the care of preterm newborns, infrastructure changes, cooperation between healthcare professionals and national policy change is needed to allow mothers and family members to be in NICUs 24/7 and make the concept of zero separation a practised reality.

Paper available at: Indian Journal of Pediatrics

Full list of authors: Harish Chellani, Sugandha Arya, Pratima Mittal, Rajiv Bahl